Fighting Fraud – NY

An upstate New York truck driver pleaded guilty this week to perjury after receiving almost $8,000 in workers’ compensation benefits while continuing to work.

Roger Decker, 48, of Lee Center, New York, gave false testimony in a hearing and falsified documents as part of a job application with the state, New York Inspector General Catherine Leahy Scott’s office said.

An investigation found that Decker was injured while working for an Oneida County trucking company in 2004. He began collecting benefits after that and later testified at a Workers’ Compensation Board hearing that he had not worked for more than a decade.

In fact, he worked for at least two trucking companies, Scott’s office reported. In total, Decker received $7,875 in Workers’ Compensation benefits in 2016.

The investigation also found that Decker submitted documents in late 2017 as part of his job application for highway maintenance worker position with the New York State Department of Transportation that falsely indicated he had never been injured while on the job. Decker was terminated from that position upon his arrest in June.

“This defendant’s false testimony and filings were part of a series of fraudulent actions meant solely to enrich himself with financial benefits to which he was not entitled,” Scott said.

Sentencing is set for Oct. 18.

Why is an IME Scheduled?

Early in a claim, there may be a question if the injury is work-related. Is the injury a pre-existing condition? Did work actually cause the condition? Is the medical condition directly related to something at work? When these issues arise, adjusters schedule the IME soon after the claim is submitted.

Later in the claim, the adjuster may feel it’s time for the worker to return to modified or regular work. When treatment seems to drag on, an IME may be scheduled. Perhaps the worker had a new, non-work accident. An IME may help sort the work condition from the non-work condition. If the treating doctor awards permanent disability higher than normally expected, an IME may be used to see if the rating is appropriate.

An IME may be scheduled more than once on a claim. The insurance carrier is entitled to examinations at reasonable intervals. If you are concerned about any of these issues and think an IME might help, call us at 1-800-523-5516 to discuss.

Independent Medical Examinations (IME)

Your workers’ compensation insurance carrier is entitled to schedule an independent medical examination, or IME. They may choose any doctor, chiropractor or psychologist. Usually, the adjuster chooses a doctor who specializes in the worker’s injury. The examination may be scheduled at any time during the claim. Once the worker is properly notified of the appointment, he or she must attend. Failure to attend places their claim on hold. Few doctors are willing to perform these examinations. They are in private practice and are not on the staff of the insurance company. Therefore, it may take a few weeks to get an appointment.

Rating Values Effective October 1, 2018

The New York State Department of Financial Services recently approved the New York Compensation Insurance Rating Board's (NYCIRB) request for an 11.7% decrease in the overall average loss costs levels effective October 1, 2018.  On July 30, 2018, NYCIRB released the loss costs for each individual classification.  The percentage change varies by class code.

CODEDESCRIPTIONNYSIF Manual Rate Effective 10/01/18NYSIF Manual Rate Effective 10/01/17Percentage Change 10/01/18 vs 10/01/17
 GROUP 455   
3726Boiler Installation/Service/ Repair13.9420.17-30.89%
5183Plumbing NOC9.8910.36-4.54%
5184Insulation11.1412.23-8.91%
5188Sprinkler Systems8.769.77-10.34%
5193Oil/Gas Burner Installation, Service, Repair12.5614.90-15.70%
5536HVAC Systems Installation incl ductwork9.5311.43-16.62%
5538Sheet Metal Work - Erection10.4013.40-22.39%
8111Plumbing Supply Dealer5.506.64-17.17%
8350Fuel Oil Dealer12.1215.09-19.68%
 GROUP 489   
5190Electrical Wiring w/i buildings7.208.34-13.67%
5191Alarm/Network/Telephone Wiring - low voltage1.962.13-7.98%
5160Elevator Installation & Service6.717.42-9.57%
3724Electrical Apparatus Installation6.967.98-12.78%
3737Electrical Apparatus Service & Repair6.727.00-4.00%
3064Sign Manufacturing – Metal10.0711.65-13.56%
4112Incandescent Lamp Mfg.2.723.51-22.51%
3643Electrical Power/Transmission Equipment Mfg3.574.13-13.56%
7536Cable Installation & Drivers / Conduit & drivers10.6311.79-9.84%
7538Electrical Light & Power Line Construction5.498.01-31.46%
7539Electrical Light & Power Company2.102.68-21.64%
7600Telephone Company & Drivers9.6110.20-5.78%
7998Hardware Stores - Retail - Electrical3.624.90-26.12%
7999Hardware Stores - Wholesale - Electrical3.073.09-0.65%
8901Telephone Company - office or exchange employees0.130.20-35.00%
8017Electrical Dealers - Retail1.972.29-13.97%
8018Electrical Dealers - Wholesale4.915.72-14.16%
9519Appliance Installation & Repair6.037.01-13.98%
9549Advertising - Outdoor4.454.78-6.90%
 GROUP 309   
4239Paper Mfg (with recycled paper/board)4.455.64-21.10%
7590Garbage Works - Reduction/Incineration7.207.071.84%
8103Clippings Dealer/Wiping Cloth Dealer & Drivers7.247.95-8.93%
8263Junk Dealer / Salvage Operations & Drivers12.3813.13-5.71%
8264Recycling Operations - Paper stock, bottle, rag, rubber - 2nd Hand Dealers & Drivers8.7410.48-16.60%
8265Iron or Scrap Dealer & Drivers13.3914.86-9.89%
9403Garbage/Refuse Removal including Drivers16.9219.00-10.95%
8018Wholesale Stores NOC - 2nd Hand Clothing Dealers4.915.72-14.16%
 GROUP 82   
2362Knit Goods Manufacturing3.003.54-15.25%
2388Embroidery Manufacturing4.175.36-22.20%
2501Clothing Manufacturing1.181.180.00%
2503Dressmaking or Tailoring Custom1.441.55-7.10%
2553Furnishing Goods Manufacturing3.804.42-14.03%
2688Leather Goods Manufacturing2.172.54-14.57%
2689Pocket Book Manufacturing1.371.60-14.38%
8032Wearing Apparel Stores – Wholesale1.371.41-2.84%
8747Showroom Salespersons0.230.29-20.69%
 GROUP 588   
7197Parcel/Package Delivery12.1413.42-9.54%
7219Trucking NOC14.6116.97-13.91%
7231Messengers NOC11.8713.84-14.23%
8292Storage Warehouse - General6.457.59-15.02%
8293Storage Warehouse - Furniture13.7516.10-14.60%

For more information please review following links

http://www.nycirb.org/bulletins/rc2468.pdf      

http://www.nycirb.org/bulletins/rc2469.pdf      

Safety and Health Committee

Safety Committees are a valuable part of your safety program.  Who participates and how often you meet will be up to your organization structure and needs.  But establishing safety committees is an excellent way management can encourage employees to participate in implementing and monitoring the company’s safety program.  When you develop your safety committee it is important to include employee representative for all departments…for example your technicians, office workers, maintainance, etc.  Members should be rotated periodically to allow for maximum involvement and increased safety awareness. 

Once an accident investigation is completed, it should be forwarded to the safety department to be reviewed at the next Safety Committee meeting. 

The Safety Committee should have an open discussion on the past accidents to determine if all the events leading up to the accident were identified, if corrective action was implemented and if the corrective measures are appropriate to prevent future incidents.  Witnesses, maintenance, supervisors, even the employees involved in the accident could be invited to the meeting to discuss the events and provide additional preventative recommendations.  This is not a process to assign blame, but rather a group effort to learn from the past and use that knowledge to prevent future accidents. The Safety Committee should also be looking for trends or problem areas while reviewing the accident investigations. 

The committee will have several roles, such as assist in the development, implementation, and periodic evaluation of the safety and health activities.  Meetings should be held regularly and all committee members must attend.  Minutes of the Safety Committee meeting should be recorded.

 The committee should be responsible for the following tasks:

  • Review existing safety and health rules and procedures to ensure that these rules are current, pertinent, and being followed.
  • Provide suggestions for employee training.
  • Review all accident reports to identify its root cause and determine appropriate corrective action by implementing one or more E.S.P. techniques:
    *    Engineering Controls
    *    Safe Work Practices
    *    Personal Protective Equipment
  • Audit the results of all safety inspections conducted.
  • Review training programs with particular attention being given to training involved in the following areas:
    *    New or transferred employees.
    *    New safety and health regulations.
    *    New or modified procedures or processes.
    *    New equipment or chemicals.
  • Be involved in preliminary hazard analysis for new equipment, new processes, and new designs.
  • Conduct periodic in-house safety inspections.
  • Provide recommendations to management on safety and health issues.
  • Evaluation of the safety and loss prevention program.

Local Law 196 of 2017: Site Safety Training (SST) Curriculum

Recent NYC Local Law 196 of 2017 requires workers and supervisors performing most construction activities within all NYC Borough jurisdiction receive safety training. The safety training requirements will be phased-in in three parts beginning on March 1, 2018, with full training being required no later than September 1, 2020.  NYC Department of Buildings will mandate that workers at certain job sites have 40 hours of safety training and that supervisors have 62 hours of training.  For more details on Local Law 196 please visit NYC Department of Buildings links below.....

Details on Safety Training Law.

Copy of Local Law 196.

Site Safety Training (SST) Curriculum.

Presentation on the New Safety Training Requirements 

Department of Buildings Announcement on Local Law 196.

List of Approved Course Providers.

You can also obtain information on OSHA classes coordinated by Keevily on our website www.keevilyworkcomp.comp